Lu Shuai, Zha Ye-Jun, Gong Mao-Qi, Chen Chen, Sun Wei-Tong, Hua Ke-Han, Jiang Xie-Yuan
Department of Orthopedic Trauma, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing 100035, China.
Chin Med J (Engl). 2021 Jan 27;134(4):390-397. doi: 10.1097/CM9.0000000000001393.
The open reduction and internal fixation (ORIF) was a standard treatment approach for fracture at distal humerus intercondylar, whereas the optimal way before ORIF remains inconclusive. We, therefore, performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs. triceps-sparing approach for patients with distal humerus intercondylar fracture.
The electronic searches were systematically performed in PubMed, EmBase, Cochrane library, and Chinese National Knowledge Infrastructure from initial inception till December 2019. The primary endpoint was the incidence of excellent/good elbow function, and the secondary endpoints included Mayo elbow performance score, duration of operation, blood loss, and complications.
Nine studies involving a total of 637 patients were selected for meta-analysis. There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 0.69-2.75; P = 0.371), Mayo elbow performance score (weight mean difference [WMD]: 0.17; 95% CI: -2.56 to 2.89; P = 0.904), duration of operation (WMD: 4.04; 95% CI: -28.60 to 36.69; P = 0.808), blood loss (WMD: 33.61; 95% CI: -18.35 to 85.58; P = 0.205), and complications (OR: 1.93; 95% CI: 0.49-7.60; P = 0.349). Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function, longer duration of operation, greater blood loss, and higher incidence of complications as compared with triceps-sparing approach.
This study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function, while the duration of operation, blood loss, and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.
切开复位内固定术（ORIF）是肱骨髁间骨折的标准治疗方法，然而在进行ORIF之前的最佳方式尚无定论。因此，我们进行了一项系统评价和荟萃分析，以评估鹰嘴截骨术与保留肱三头肌入路治疗肱骨髁间骨折患者的疗效和安全性。
从最初建库至2019年12月，在PubMed、EmBase、Cochrane图书馆和中国知网进行系统的电子检索。主要终点是肘关节功能优/良的发生率，次要终点包括梅奥肘关节功能评分、手术时间、失血量和并发症。
9项研究共纳入637例患者进行荟萃分析。鹰嘴截骨术与保留肱三头肌入路在肘关节功能优/良发生率（优势比[OR]：1.37；95%置信区间[CI]：0.69-2.75；P = 0.371）、梅奥肘关节功能评分（加权均数差[WMD]：0.17；95%CI：-2.56至2.89；P = 0.904）、手术时间（WMD：4.04；95%CI：-28.60至36.69；P = 0.808）、失血量（WMD：33.61；95%CI：-18.35至85.58；P = 0.205）和并发症（OR：1.93；95%CI：0.49-7.60；P = 0.349）方面均无显著差异。敏感性分析发现，与保留肱三头肌入路相比，鹰嘴截骨术可能与肘关节功能优/良发生率更高、手术时间更长、失血量更大以及并发症发生率更高相关。
本研究发现，鹰嘴截骨术在肘关节功能优/良发生率方面未产生额外益处，而采用鹰嘴截骨术治疗的患者在手术时间、失血量和并发症方面可能不如保留肱三头肌入路。
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